Hormone Deficiency Test Do you have Hormone Deficiencies? This is a selt-test to help you determine if your hormone levels are below normal. This is designed to help you and your doctor select the correct treatment for you. Check the score for each line then total the score at the bottom of each hormone. Step 1 of 10 10% EstrogenI'm losing hair on top of my head0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI'm getting thin, vertical wrinkles above my lips0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy breasts are droopy0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy face is too hairy0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy eyes are dry and easily irritated0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have hot flashes0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel tired constantly0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI am depressed0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy menstrual flow is light0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy periods are irregular0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyWomen without periods: I do not feel like sex anymore0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyLeave at 0 if you still get your period.Your Overall Score for Estrogen10 or less = satisfactory level 11-20 = possible estrogen deficiency 21 or more = probably estrogen deficiency ProgesteroneMy breasts are large0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy close friends complain I'm nervous and agitated0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel anxious0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI sleep lightly and restlessly0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyNext 5 questions for women who have NOT reached menopause and menopausal women who are taking hormone replacement therapyMy breasts are swollen and tender before my period0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy belly is swollen0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI'm irritable and aggressive0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI lose my self-control0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have heavy periods0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy periods are continuously painful0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for Progesterone4 or less = satisfactory level 5-8 = possible progesterone deficiency 9 or more = probably progesterone deficiency ThyroidI'm sensitive to cold0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy hands and feet are always cold0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyIn the morning my face is puffy and my eyelids are swollen0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI put on weight easily0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have dry skin0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have trouble getting up in the morning0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel more tired at rest than when I am active0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI am constipated0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy joints are stiff in the morning0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel like I am living in slow motion0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for Thyroid10 or less = satisfactory levels 11 - 20 = possible thyroid hormone deficiency 21 or more = probably thyroid hormone deficiency PregnenoloneI have memory loss0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy joints hurt0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI'm feeling a bit drained and it is hard to handle stress0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI don't see colors as brightly as before0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have lost interest/appreciation for art0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI don't have much hair under my arms or pubic area0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel more tired at rest than when I am active0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have abundant, light-colored urine during the day0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have low blood pressure0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI crave salty foods0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for Pregnenolone10 or less = Satisfactory level 11 - 20 = possible Pregnenolone deficiency 21 or more = probably Pregnenolone deficiency MelatoninI look older than I am0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have trouble falling asleep at night0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI wake during the night0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyAnd I can't get back to sleep0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have anxious thoughts while trying to fall asleep0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy feet are too hot at night0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyWhen I get up, I don't feel rested0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI go to bed late and wake up late0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI can't tolerate jet lag0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI smoke, drink and/or use a sleep aid0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for Melatonin10 or less = satisfactory level 11-20 = possible melatonin deficiency 21 or more = probably melatonin deficiency Growth HormoneMy hair is thinning0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy cheeks sag0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy gums are receding0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy abdomen is flabby0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy muscles are slack0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy skin is thick and/or dry0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyIt's hard to recover after physical activity0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel exhausted0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI don't feel like interacting with the world, I tend to isolate myself0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel continuously anxious and worried0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for Growth Hormone10 or less = satisfactory level 11 - 20 = possible growth hormone deficiency 21 or more = probably growth hormone deficiency DHEAMy hair is dry0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy skin and eyes are dry0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy muscles are flabby0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy belly is getting fat0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI don't have much hair under my arms or pubic hair0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyDon't have much fatty tissue in the pubic area0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy body doesn't have much of a special scent during sex0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI can't tolerate noise0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy libido is low0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for DHEA10 or less = satisfactory level 11 - 20 = possible DHEA deficiency 21 or more = probably DHEA deficiency CortisolMy face looks thinner0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy friends call me skinny0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have eczema, psoriasis, or other rashes0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy heart beats quickly0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy blood pressure is low0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI crave salt or sugar0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have digestive problems0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI am stressed out0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI am easily confused0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for Cortisol10 or less = satisfactory level 11 - 20 = possible cortisol deficiency 21 or more = probably cortisol deficiency TestosteroneMy face has gotten slack and more wrinkled0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI've lost muscle tone0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy belly tends to get fat0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI'm constantly tired0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel like making love less often than I used to0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyThe rest of the questions are for men only:My breasts are getting fatty0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI feel less self-confident and more hesitant0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyMy sexual performance is poorer than it used to be0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI have hot flashes and sweats0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyI tire easily with physical activity0 = Never1 = Sometimes2 = Regularly3 = Often4 = ConstantlyOverall Score for TestosteroneFor Women Only: 5 or less = satisfactory level 6-10 = possible testosterone deficiency 11 or more = probably testosterone deficiency For Men Only: 10 or less = satisfactory level 11 - 20 = possible testosterone deficiency 21 or more = probably testosterone deficiency Part II - Answer the ailments and discuss them with your physician:EnergyDo you have a hard time getting up in the morning?YesNoDo you always feel tired in the afternoon?YesNoSexDo you lack sexual desire?YesNoDoes your penis or clitoris seem less sensitive?YesNoAre your erections not firm enough?YesNoHave you lost your attraction towards your partner?YesNoDo you lack vaginal lubrication?YesNoSleepDo you sleep poorly?YesNoDo you rarely dream?YesNoMemoryDo you suffer from memory loss?YesNoDo you have trouble concentrating?YesNoSkin and HairDo you have wrinkles along the nose, smile lines or forehead?YesNoDo you have little wrinkles around the eyes and crow's feet?YesNoDo you have age spots?YesNoDo you have dry, thin skin?YesNoAre you losing your hair or is it turning gray?YesNoStress and MoodDo you suffer from constant fatigue?YesNoDo you have high blood pressure?YesNoAre you anxious, nervous, or irritable?YesNoDo small things set you off?YesNoAre you depressed?YesNoJoints and BonesDo you have arthritis?YesNoDo you have osteoarthritis?YesNoDo you have fibromyalgia (sharp shoulder pain)?YesNoHave you lost muscle mass, tone, and strength?YesNoDo you have bone loss of the spine, hips, hands, wrists or feet?YesNoTell us about youThis is optional. Let us know how we can help you with your symptoms. Dr. Odom is very sympathetic to all her patients and only wants the best treatments for each individual.Name* First Last Phone*Email* Comments and questions: